Provider Demographics
NPI:1437359205
Name:CARR, MARCIA JEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:JEAN
Last Name:CARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1147
Mailing Address - Country:US
Mailing Address - Phone:810-600-1400
Mailing Address - Fax:810-600-1403
Practice Address - Street 1:3565 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2876
Practice Address - Country:US
Practice Address - Phone:313-827-3800
Practice Address - Fax:313-827-3803
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant